The term ventilation disorders is used in human medicine to describe disorders in inhalation and exhalation. A distinction is made between obstructive, restrictive, and neuromuscular ventilation disorders. Obstructive refers to an increase in airway resistance, restrictive refers to a decrease in vital capacity or total lung capacity, and neuromuscular refers to a nerve-related motor limitation of breathing.
What are ventilatory disorders?
The term ventilatory disorder is used in human medicine to refer to both an obstruction to breathing caused by increased breathing resistance and decreased lung capacity – and therefore decreased vital capacity. Increased airway resistance can be caused by obstructions in the airways or by external pressure on the airways. Such airway resistance is called obstructive. Restrictive ventilatory dysfunction occurs when lung volumes are restricted due to an alteration in the lung functional tissues. Similarly, obstruction of breathing due to neuromuscular disease or injury to the chest corresponds to a restrictive ventilatory disorder. It usually involves decreased compliance of the respiratory system and, therefore, decreased vital capacity. Both mechanical-muscular and neuromuscular problems with breathing and an alteration of the functional tissue (parenchyma) of the lungs and bronchi are equally referred to as restrictive ventilation disorders. Neuromuscular ventilation disorders refer to restrictions caused by nerves, such as those that can occur in paraplegia or when the higher-level respiratory centers in the brain are dysfunctional.
Causes
The precipitating factors of a ventilatory disorder vary widely. They can be distinguished between causing an obstructive, restrictive, or even neuromuscular disorder. For example, allergic bronchial asthma and chronic obstructive pulmonary disease (COPD) lead to a classic form of obstructive ventilation disorder. Both diseases entail a reduction of the lumen in the bronchi due to swelling of the mucous membrane, thickening of the contracting bronchial muscles and secretion of a viscous mucus, thus increasing airway resistance. Obstructive ventilation disorders also include narrowing of the airways caused, for example, by space-occupying structures such as tumors. Causes of a classic restrictive ventilation disorder include pulmonary fibrosis, paralysis (paresis) or stiffening of the diaphragm, or pleural effusion. Characteristic of pulmonary fibrosis, which can have many different causes, is the gradual remodeling of functional lung tissue into connective tissue-like structures with gradual loss of function. Pleural effusion, an excessive accumulation of fluid between the two sheets of the pleura, also has a variety of possible causative factors.
Symptoms, complaints, and signs
Signs and symptoms of a ventilatory disorder covers a wide range and is largely dependent on the underlying disease or causative factors. For example, chronic bronchitis, which can develop into COPD, is noticeable by a productive cough that can last for years. In addition, exertional dyspnea often becomes apparent as the disease progresses. In a severe form of progression, resting dyspnea may also be evident. Ventilatory dysfunction caused by an acute asthma attack may produce acute dyspnea because the airways become almost completely blocked. Persistent coughing, increase in pulse rate, and marked cyanosis with blue lips may be assessed as secondary symptoms that develop because of decreased oxygenation. The remaining culprits of obstructive or restrictive ventilatory dysfunction are usually characterized by nonspecific exertional or resting dyspnea and coughing irritability associated with increased mucus production.
Diagnosis and course of the disease
Ventilatory disorders are always an expression of different underlying diseases, so that the diagnosis of an obstructive, restrictive, or neuromuscular ventilatory disorder often does not include a statement about the causative factors.A variety of diagnostic tools within a pulmonary function test are available for the detection of a ventilation disorder, such as spirometry with measurement of vital capacity and various static and dynamic parameters. A little more complex is the so-called bodyplethysmography or whole-body plethysmography, which requires a closed cabin with specialized technology. The procedure provides information about pressure ratios in the chest and airway resistance, as well as some other parameters such as total lung capacity and residual non-expiratory volume. The course of a ventilation disorder depends on the underlying disease causing it. In the case of COPD or pulmonary fibrosis, a severe course with an unfavorable prognosis may occur if left untreated.
Complications
Depending on the cause, ventilatory dysfunction can cause various respiratory complications. For example, if the disorder occurs in the setting of chronic bronchitis, the typical symptoms, i.e., cough, sputum, and shortness of breath, increase during the course of the disease and are associated with a shortened life expectancy. A possible sequelae is tachycardia, abnormal heart palpitations, which can lead to further diseases of the cardiovascular system. Furthermore, cyanosis, in which the skin turns blue, may occur in conjunction with a persistent ventilatory disorder. During the course of the disorder, exertional dyspnea or resting dyspnea often develops if the underlying disease is severe. Ventilatory disorders in the course of an acute asthma attack can lead to acute respiratory distress. In extreme cases, suffocation symptoms and a panic attack occur. Untreated ventilation disturbances are particularly problematic, because in the later stages they can cause consequential damage to the brain (due to chronic oxygen deficiency) and the lungs. In treatment, the risks come mainly from the prescribed drugs, which are often associated with side effects and interactions.
When should you see a doctor?
Disturbances of respiratory activity should always be clarified by a doctor if they persist for several weeks or months. In the event of acute respiratory distress, a physician should be consulted immediately. If there is a loss of consciousness due to the lack of oxygen, an ambulance service must be alerted. In addition, persons present must apply mouth-to-mouth resuscitation from the first aid catalog. This is the only way to ensure the survival of the victim. Dizziness, unsteadiness of gait, a general weakness or disturbances of attention and concentration indicate health irregularities that should be clarified by a doctor. A pale complexion, irregularities in heart rhythm, and sleep disturbances are other complaints that need to be investigated. Heavy breathing, interruptions in breathing activity, and general dysfunction are signs of a ventilatory disorder. A diagnosis by a physician is necessary so that a treatment plan can be established. If the patient is unable to perform daily tasks or has problems with sports, it is advisable to clarify the cause. In case of an inner feeling of pressure, a general malaise as well as a quick fatigability, the observations should be discussed with a doctor. Loss of zest for life, apathy and withdrawal from social life should be interpreted as warning signals. A visit to the physician is advised so that the reasons for the health impairments can be determined.
Treatment and therapy
Treatment of ventilatory dysfunction is always directed at treating the underlying disease causing it. If it is one caused by long-term inhalation of toxic fumes or dusts or by cigarette smoke, the first part of a therapy is to avoid the substances in the future. The next stage of a treatment usually consists of treatment with beta2-mimetics, so-called bronchodilators, so that the vascular muscles of the airways relax and the airways dilate. The drugs can also be taken in the form of breathing sprays. This has the advantage that the active ingredient is delivered directly to the affected tissue in a simple manner. If chronic airway inflammation is a contributory cause of the ventilation disorders, corticosteroids are often used.However, long-term use of cortisone must also take into account its side effects, which may include a weakening of the immune system against infections. In some cases, where there is already a chronic undersupply of oxygen, an additional oxygen supply by means of a mask may be necessary. In very severe cases, for example, airways that have been narrowed and totally obstructed by surgery can be reopened or bypassed. As a last resort, lung transplantation is also performed if the patient is untreatable.
Prevention
Direct preventive measures that might prevent ventilatory dysfunction do not exist because the disease is either based on an underlying causative disease or on inhalation of long-term toxic dusts or aerosols. If it is not possible to keep away from certain toxic substances, including cigarette smoke, it is recommended that lung function tests be carried out at regular intervals of about three to five years. The ventilation disorder is a daily burden for the patient. Due to frequent breathing difficulties, many sufferers are dependent on respiratory equipment. Follow-up care is advisable to restore or maintain quality of life. The patient should be proficient in the everyday use of breathing aids. At follow-up appointments, he or she learns the correct use of such aids.
Follow-up care
Ventilatory dysfunction can be due to acute and chronic causes. Therefore, the duration and extent of follow-up care depend on the underlying disease. For chronic lung disease such as COPD or bronchial asthma, close follow-up is required, and the pulmonologist applies it on a long-term basis. In the case of an acute trigger, the actual disease is remedied. During the follow-up, the specialist checks whether the condition is improving. Follow-up examinations are continued until the symptoms have subsided. The patient is prescribed soothing medication to combat secretions and coughing. In addition, the aftercare includes people close to the patient. They are informed about first aid measures. Acute respiratory distress can be recognized and treated in time. A balanced diet rich in vitamins, avoidance of too high stress levels, as well as visiting self-help groups contribute to the improvement of the condition. Follow-up care in this case is more like preventive care.
Here’s what you can do yourself
Depending on the severity of the underlying condition, a ventilatory disorder can significantly reduce the quality of life of the affected person. From a psychological perspective, it is primarily important to maintain a social environment. In particular, a sudden worsening of the disease can lead to an inability to work and to social problems. The consequences are often depression and a further deterioration of the state of health. Exchanging information with other sufferers in forums or self-help groups breaks this downward spiral. There, sufferers not only find experiences, but also receive up-to-date information on doctors, sports groups and other points of contact. From a medical point of view, it is particularly important that the sufferer adheres to treatment. Regular discussions with the physician facilitate the implementation of a well-coordinated therapy. Special lung sports are particularly important in the case of a ventilation disorder. Patients can support these measures themselves by exercising at home and remaining physically active. In addition, general measures such as sufficient rest and stress avoidance apply. If necessary, the diet must be adjusted to accommodate the progressively advancing disease. The COPD Deutschland e. V. association can provide sufferers with further tips and measures for treating a ventilation disorder.
